@layout("/common/_container.html"){
<div class="ibox float-e-margins">
    <div class="ibox-content">
        <div class="form-horizontal">
            <div class="row">
                <div class="col-sm-6 b-r">
                    <#input id="paientIdcard" name="居民身份证号" underline="true"/>
                    <#input id="paientName" name="居民姓名"/>
                </div>
                <div class="col-sm-6">
                    <#input id="paientMoney" name="医保余额" underline="true"/>
                </div>
            </div>
            <div class="row btn-group-m-t">
                <div class="col-sm-10">
                    <#button btnCss="info" name="提交" id="ensure" icon="fa-check"
                    clickFun="PatientInfoInfoDlg.addSubmit()"/>
                    <#button btnCss="danger" name="取消" id="cancel" icon="fa-eraser"
                    clickFun="PatientInfoInfoDlg.close()"/>
                </div>
            </div>
        </div>
    </div>
</div>
<script src="${ctxPath}/static/modular/patient/patientInfo/patientInfo_info.js"></script>
@}
